NorthShore University HealthSystem, Evanston, IL.
NorthShore University HealthSystem, Evanston, IL.
J Am Coll Surg. 2018 Jul;227(1):106-114. doi: 10.1016/j.jamcollsurg.2017.12.054. Epub 2018 Feb 14.
The aim of this study is to investigate patient-centered quality of life (QOL) outcomes in patients undergoing laparoscopic paraesophageal hernia repair.
We prospectively followed patients who underwent laparoscopic paraesophageal hernia repair between 2009 and 2016. The QOL outcomes were measured using the 36-Item Short Form Health Survey, GERD Health Related Quality of Life, Reflux Symptom Index, and Dysphagia score surveys administered preoperatively and at 3 weeks, 6 months, 1 year, and 2 years postoperatively. Postoperative QOL outcomes were compared with preoperative baseline scores using paired t-tests.
Of 314 total patients who underwent laparoscopic paraesophageal hernia repair, 188 with adequate follow-up were included in analysis. Mean age was 69.1 ± 11.8 years and 22.3% of studied subjects were male. Most of the cohort also underwent laparoscopic fundoplication (95.7%). Prevalent symptoms at initial presentation include heartburn (65.4%) and regurgitation (60.1%). Significant improvements between baseline and all postoperative time points were seen in Reflux Symptoms Index (3 weeks: p < 0.0001, 6 months: p = 0.005, 1 year: p = 0.0004, and 2 years: p = 0.002) and GERD Health Related Quality of Life scores (3 weeks: p < 0.0001, 6 months: p = 0.0019, 1 year: p < 0.0001, and 2 years: p = 0.0003). Dysphagia scores were worse at 3 weeks but lost significance at all other time points. The 36-Item Short Form Health Survey measures of Energy/Fatigue (p = 0.0099), Emotional Well-Being (p = 0.0393), Social Functioning (p = 0.0278), Pain (p = 0.0021), and Role Limitations Due to Physical Health (p = 0.0009) were significantly improved 2 years postoperatively.
Laparoscopic paraesophageal hernia repair results in significantly improved QOL as measured by the 36-Item Short Form Health Survey at both short- and long-term intervals. Additionally, Reflux Symptom Index and GERD Health Related Quality of Life scores improved at all postoperative time points.
本研究旨在探讨腹腔镜食管裂孔疝修补术后患者的以患者为中心的生活质量（QOL）结局。
我们前瞻性随访了 2009 年至 2016 年间接受腹腔镜食管裂孔疝修补术的患者。在术前和术后 3 周、6 个月、1 年和 2 年时，使用 36 项简短健康调查、胃食管反流病健康相关生活质量、反流症状指数和吞咽困难评分调查来测量 QOL 结局。使用配对 t 检验将术后 QOL 结局与术前基线评分进行比较。
在 314 例接受腹腔镜食管裂孔疝修补术的患者中，有 188 例具有足够的随访结果被纳入分析。平均年龄为 69.1±11.8 岁，22.3%的研究对象为男性。该队列中大多数患者还接受了腹腔镜胃底折叠术（95.7%）。最初表现出的常见症状包括烧心（65.4%）和反流（60.1%）。在 Reflux Symptoms Index（3 周：p<0.0001，6 个月：p=0.005，1 年：p=0.0004，2 年：p=0.002）和 GERD Health Related Quality of Life 评分（3 周：p<0.0001，6 个月：p=0.0019，1 年：p<0.0001，2 年：p=0.0003）方面，基线和所有术后时间点之间均有显著改善。吞咽困难评分在 3 周时更差，但在所有其他时间点均失去了意义。36 项简短健康调查的能量/疲劳（p=0.0099）、情绪健康（p=0.0393）、社会功能（p=0.0278）、疼痛（p=0.0021）和因身体健康而导致的角色限制（p=0.0009）等方面的得分在术后 2 年显著改善。
腹腔镜食管裂孔疝修补术可显著改善 QOL，在短期和长期随访中，36 项简短健康调查的得分均有改善。此外，Reflux Symptom Index 和 GERD Health Related Quality of Life 评分在所有术后时间点均有所改善。
